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Phase 3A > Psych condensed > Flashcards

Psych condensed Flashcards

1
Q

What is an advanced directive?

A

Legally binding document - Made with capacity

Stipulates patients refusal of certain medical interventions

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2
Q

What is the court of protection?

A

Make decisions if no LPA

Resolves disputes if there is disagreement with treatment plans

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3
Q

What are DOLS?

A

Allows deprivation of liberty over someone who lacks capacity
Legal framework for hospital / care environment if it is in patient’s best interests

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4
Q

Name 5 principles of the mental health act

A

Maximize patient and public safety

Minimize the impact of mental illness on the patient

Minimize restriction of liberty

Use the least restrictive option

Effectiveness of proposed treatment

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5
Q

Describe section 2 of MHA

A

ASSESSMENT

Duration - 28 days

2 doctors - S12 and AMHP

Can be coercively treated

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6
Q

Describe section 3 of MHA

A

TREATMENT

Duration - 6m

2 doctors - S12 and AMHP

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7
Q

Describe section 4 of MHA

A

EMERGENCY

Duration - 72 hours

Proffesionals - 1 doctor and AMHP

Usually converted to S2

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8
Q

Describe a section 5(2)

A

DOCTOR order

Duration - 72hours

For patient already admitted

No coercieve treatment - just legal framework to restrain

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9
Q

Describe a Section 5(4)

A

NURSES order

Duration - 6 hours

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10
Q

Describe a section 135

A

Court order to enter house and move to place of safety for assessment

Proffesionals - ASW + medical professional + Polcie

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11
Q

Describe a section 136

A

Duration 24 hours

Arrest a person and bring to place of safety

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12
Q

Describe the key principles of MCA

A

Assume capacity

Least restrictive option to patients rights

Respect unwise decisions

Decisions must be in their best interests

Help must be given to aid in their capacity

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13
Q

what is an illusion

A

Misinterpretation of real external stimulus

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14
Q

what is a hallucination

A

Perception in absence of external stimulus

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15
Q

what is a delusion

A

false belief firmly maintained despite evidence of contrary

Out of keeping with patients social and cultural background

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16
Q

What is the MOA of antipsychotics

A

Block parasympathetic D2 receptors in mesolimbic pathway

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17
Q

What pathways are affected by excess dopamine in schizophrenia

A

Mesoimbic - Positive sx

Mesocortical - Negative sx

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18
Q

What pathways do antipsychotics target / have an effect on

A

Block D2 receptors - Mesolimbic

Hyperprolactniaemia - Tuberoinfundibular

EPSE - Nigrostriatal

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19
Q

When should antipsychotics be cautioned

A

Elderly - Stroke and VTE risk

Drugs prolonging QT - Amiodarone / Macrolides

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20
Q

What are the side effects of typical antipsychotics

A 
EPSE 
Drowsy 
Hypotension 
QT Prolongation 
Erectile dysfunction 
Hyperprolactinameia
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21
Q

What are the side effects of atypical antipsychotics

A

Metabolic disturbance - Lipid changes / DM
Weight gain
Prolonged QT interval
Hyperprolactinameia - Sexual dysfunction

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22
Q

How long should you continue antipsychotics after an acute episode

A

5 years

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23
Q

Name 5 side effects of clozapine

A 
Reduce seizure threshold 
Agranulocytosis 
constipation 
Hypersalivation 
Myocarditis
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24
Q

What affects clozapine levels

A

Smoking and alcohol - decreases levels

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25
Q

Name the order that EPSE appear

A

Acute dystonia
Akinthesia
Tardive dyskinesia
Parkinsonism

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26
Q

What is acute dystonia

A

Occurs after HOURS

Sustained msucle contraction - torticollis / oligouric crisis

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27
Q

How do you treat acute dystonia

A

Procyclidine

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28
Q

What is akinthesia

A

Develops after days to weeks

restlesness
tremor

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29
Q

What is the treatment of akinthesia

A

Propanolol

Cyproheptadine

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30
Q

What is tardive dyskinesia

A

> 6m usage

Repititive actions - grimacing / lip smacking / tongue protrusion

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31
Q

What is the treatment for tardive dyskinesia

A

Tetrabenzine - D2 agonsit

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32
Q

What is the treatment of Parkinsonism

A

Procyclidine

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33
Q

Name 8 side effects of SSRIs

A 
Size - weight gain 
Sick - N+V
Seizure - Reduce threshold 
Suicide 
Sodium - Hyponatramia 
Sexual dysfunction 
Sleep / stress
 Stomach upset - dyspepsia / Abdo pain
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34
Q

When should SSRIs be cautioned

A

PUD
Epilepsy
young patients

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35
Q

What drugs interact with SSRIs

A

MOA + Triptans –> S.S

NSAIDs/Aspirin –> Requires PPI

Antipsychotics –> QT prolongation

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36
Q

Describe SSRI withdrawl sx

A 
Mood change 
Sleep issues 
Sweating 
Restlesness 
D+V
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37
Q

Howlong should SSRIs be continued for

A

6m

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38
Q

Name 2 SNRIs

A

Venelefaxine

Duloxetine

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39
Q

Name CI to venelafaxine

A

Raises BP - CI in cardiac disease

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40
Q

Name 5 side effects for TCA

A

Anticholinergic

  • urinary retention
  • blurred vision
  • constipation
  • confusion

Anti-adrenergic

  • Postural hypotension
  • Impitence
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41
Q

Describe a TCA overdose

A 
Confusion 
Arrhythmias - QT prolongation 
seizures 
flushing 
dialted pupils 
vomiting
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42
Q

What would an ABG in a TCA overdose show

A

Metabolic acidosis

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43
Q

TCA overdose management

A

Supportive
Activated charcoal (2-4 hours)
IV bicarbonate

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44
Q

What should be avoided when taking MAOI

A

Cheese
Beer
red wine
smoked meat or fish

contain tyrmaine - vasoconstrictor

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45
Q

Treatemnt for hypertensive crisis in MAOI

A

Phentolamine

46
Q

What affects Lithium levels

A

Dehydration and volume depletion
Thiazide diuretics
ACEi / NSAIDs - affect kidney fucntion

47
Q

Theraputic side ffects to lithium

A 
L - Leukocytosis 
I - Diabetes insipidus 
T - Fine tremor 
H - Hypperparathyroid 
I - Increased GI motility 
U  - Underactive thyroid 
M - Ebsteins anomoly
48
Q

Toxic lithium side effects

A 
T - Coarse tremor 
O - Oliguria 
X - Ataxia 
I - Increased reflexes 
C - coma / convulsions
49
Q

What are the effects of pscyhiatric medications in the elderly

A

Higher fat/water distribution - Reduced Benzo dose

reduced renal and heaptic functions

slower titration of meds

50
Q

Describe serotonin syndrome

drugs
presentation
management

A

SSRIs / Triptans / MAOI / Ecstacy / Tramadol / St john wart

INCREASED ACTIVITY

  • clonus / myoclonus
  • Increased reflexes
  • Rigidity
  • tremor
  • dialted pupils
  • Autonomic sx (Tachy /unstable BP / Hyperthermia)

IV fluids
BDZs
Cryproheptadine - serotonin antagonist

51
Q

Desribe NMS

A

Antipsychtoics / Withdrawl of dopaminergic drugs

Lead pipe rigidity
normal pupils
Hyporeflexia
Autonomic sx (Tachy / sweating / unstable BP / hyperthermia)

Stop antipsychotics
IV fluids
Bromocriptine / Dantrolene

52
Q

What metabolic presentation is present in NMS and SS

A

Metabolic acidosis

53
Q

What would FBC shouw in NMS

A

Leukocytosis

54
Q

Why is it important to check U+E in NMS

A

Increased CK –> AKI

Rhabdomyolysis

55
Q

How many features and for how long are required for it to be classified as a dependence disorder

A

3 features for > 1 month

56
Q

Name 5 features of dependence

A 
continued use despite harm 
salience 
narrowed repitoire 
withdrawal 
cravings 
tolerance 
loss of control 
rapid reinstatement
57
Q

How do metronidazole and alcohol interact

A

Metronidazole inhibits acetaldehyde dehydrogenase leading to build up of acetaldehyde

Drinking –> N+V / Headache / Sweating

58
Q

Alcohol units calcualtion

A

% x volume (ml) divided by 1000

59
Q

Psychological management of addictive behaviours

A

1 - Maintenence or withdrawal

2 - Motivational interviewing / AA / FRAMES

60
Q

Name 3 drugs used in alcohol withdrawal

A

Disulfram
Acamprosate
Naltrexone

61
Q

MOA of disulfram

A

Inhibits acetaldehyde dehydrogenase - S/E if alcohol ingested

flushing
headache
reduced BP
Nausea

62
Q

MOA of acamprosate

A

Reduces craving by inhibiting glutamate

63
Q

MOA of naltrexone

A

Opiod antagonist - reduces pleasure alcohol brings

64
Q

Alcohol withdrawl - sx 6/12 hours post

A 
Tremor 
sweating 
N+V 
Anxiety 
Tachycardia
65
Q

Alcohol withdrawl - 12-24 hours post

A

Hallucinations

66
Q

Alcohol withdrawl - 36 hours post

A

Seziures

67
Q

Alcohol withdrawl - 72 hours post

A

DELIRIUM TREMENS

Altered consciousness
Persucotary delusions
coarse tremor

Tachycardia
sweating
Increased BP
Fever

Halluciantions - Lilluptian / formication

68
Q

What is the management of delirium tremens

A

Chlorodiazepioxide
Thiamine
Pabrinex

69
Q

Describe opiate intoxication

A 
drowsy 
reduced resp rate 
Pinpoint pupils 
Decreased BP 
Decreased HR
70
Q

Describe opiate withdrawl

A

EVERYTHING RUNS

Rhinorrhoea 
Lacrimation 
Pupil dialtion 
Sweating 
Diarrhoea 
N+V
Agitation
Abdominal cramps
71
Q

Describe opiate withdrawl management

A

Lafexidine

BDZs - agitation

Antimetics

72
Q

Describe opiate overdose

A 
Pinpoint pupils 
coma 
resp depression 
seziures 
Hypothermia
73
Q

Describe opiate overdose managemnt

A

IV/IM Naloxone - short half life
O2
IV hydration

74
Q

What drugs can be used for substance abuse dependence

A

Methadone - logn acting

Buprenorphine - Partial agonsit

Naltrexone - for patients completing detox

75
Q

substance abuse Short term complications

A

VTE
PE
Infection - IE
Respiratory depresion - acidosis

76
Q

Describe BDZs overdose

A 
anxiety 
insominia 
tremor 
agitation 
headache 
seizures
77
Q

Describe cannabis intoxication

A 
drowsy 
imapired memory 
slow reflexes 
bloodshot eyes 
increased appetite
78
Q

causes of delirium

A 
D - Drugs (Anticholinergic/ BDZs/Anticonvulsant
E - Electrolyte 
L - Lack of drug (opiates /levodopa/alcohol)
I - Infective 
R - Retention / reduced sensory 
I - Intracranial (stroke / post ictal)
U - Underhydration/nutrition 
M - Myocardial
79
Q

RF for Alzehimers disease

A 
FHx 
Downs syndrome 
Apolipoprotein E4 
Depression 
Female 
Age
80
Q

Alzheimers sx

A 
Amnesia 
Aphasia 
Agnosia 
Apraxia 
Apathy 
Depression
81
Q

Alzehimers Mx

A

Acetylcholinesterase inhibitors - Rivistagmine / Donepezil

NDMA receptor antagonist - Memantine

82
Q

Alzehimers Mx

A

Acetylcholinesterase inhibitors - Rivistagmine / Donepezil

NDMA receptor antagonist - Memantine

83
Q

Adverse effects of ACh inhibitors

A

Headache / Diarrhoea / Bradycardia

84
Q

Adverse effects of memnatine

A 
confusion 
hallucination
dizzy 
seizure 
constipation
85
Q

GAD management

A

1 - Education and active mointioring
manage co-morbidities
exercise
sleep hygiene

2 - Low intensity psychological
Guided self help
Psychoeducation

3 - High intensity intervention
CBT/Applied relaxation +/- SSRI

4 - CBT + SSRI

86
Q

Panic disorder presentation

A

Sx peak within 10 mins

P – Palpitations
A – Abdominal distress 
N – Numbness/nausea
I – Intense fear of death
C – Choking/chest pain 
S – Sweating/shaking/SOB
D – depersonalization/derealization
87
Q

Describe the characteristics of the obsessions in OCD

A

Intrusive
Recognised as patients own thoughts
Non sensical - unlide delusions

88
Q

Management of OCD

A

1 - Low intensity CBT / ERP

2 - High intensty CBT / ERP OR SSRI

3 - High intensity CBT/ERP + SSRI / TCA

89
Q

How long should you continue medication for in OCD

A

12 months

90
Q

What are the requirements for PTSD diagnosis

A

Sx arise within 6m of event

Sx present for > 1 month with functional impairment

91
Q

Describe PTSD presentation

A

Hyperarousal - startle / seep issues
Flashbacks
Avoidance
Emotional numbing

92
Q

PTSD management

A

1 - Trauma focused CBT / EMDR

2 - Sertraline / Venelfaxine

93
Q

PTSD management

A

1 - Trauma focused CBT / EMDR

2 - Sertraline / Venelfaxine

94
Q

What are the componenets of the SCOFF questionnaire

A 
S - Sick 
C - control 
O - one stone (3m)
F - Fat 
F - Food domiantes
95
Q

Name 6 features of anorexia

A 
Arrhythmias - QT prolongation 
Lanugo hair 
yellow tinge to skin 
constipation 
swelling of parotid and submandibular glands
96
Q

Features of hypokalaemia

A 
Flat t waves 
T wave inversion 
U waves 
ST depression 
Arrhythmias - VT
97
Q

Biochemical features of anorexia

A

Increased G + C

  • GH
  • Cortisol
  • Beta carotene
  • Cholesterol
98
Q

Anorexia red flags

A

BMI < 13.5Kg
>1kg/week weight loss
Temp < 34.5
Proximal muscle weakness

99
Q

Anorexia management - Adult

A

1 - CBT - ED

2 - MANTRA

100
Q

What does MANTRA stand for

A

Maudsley Model of Anorexia Nervosa Treatment for Adults

101
Q

Anorexia management - Child

A

1 - Family focused therapy

2- CBT

102
Q

Anorexia complications

A

Osteoperosis

cardiac atrophy

103
Q

Long term anorexia management

A

DEXA scan

104
Q

Refeeding syndrome presentation

A 
Oedema 
tachycardia 
confused 
CCF
Blaoting
105
Q

What metabolic disturbances occur in bulimia

A

Laxatives - acidosis

Purging - alkalosis

106
Q

What complication occurs with long term laxative use in bulimia

A

Cardiomyopathy

107
Q

bulimia management

A

1 - BN focused guided self help

4 weeks

2 - CBT - ED

108
Q

Criteria for depression diangosis

A

5/9 sx

D - Depressed mood
E - Energy low
A - Anhedonia
D - Dead thoughts

S - Sleep 
W - Worthlesness 
A - Apetite / weight 
M - Mentation decreased 
P - Psychomotor retardation
109
Q

DDx of depression

A 
Parkinsons 
dementia 
Hypothyroid 
Hypoadrenalism 
Steroids 
Alcohol 
DM
110
Q

Features of mania

A

Sx present for 7 days

marked fucntional impairment
Psychotic sx
- delusions of grandeur
- Auditory hallucinations

Phase 3A (12 decks)

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